基于中医证型探讨早中期结直肠癌患者根治术后心理负担与肠道菌群分布的关系

Exploring the correlation between psycho-emotional burden and intestinal flora distribution in patients after radical surgery for early to mid-stage colorectal cancer based on TCM characteristic factors

目的基于中医证型探讨早中期结直肠癌患者根治术后心理负担与肠道菌群分布的关系。方法采用横断面研究方法,纳入2020年10月—2021年7月中国中医科学院西苑医院与北京大学肿瘤医院中西医结合心身康复平台诊治的早中期结直肠癌患者共44例,基于中医辨证分型及中医脾虚量表(TCM-SDS)、中医肾虚量表(TCM-KDS)等中医证型因素对患者进行分组,分析比较不同脾虚肾虚程度的早中期结直肠癌患者心理情绪负担分布以及肠道菌群多样性差异,并通过物种差异比较及环境因子分析判断不同程度中医证型及心理情绪负担对肠道菌群的影响。结果44例早中期结直肠癌患者中,肝郁脾虚证20例(45.4%)、脾肾两虚证17例(38.6%),痰湿内阻证5例(11.4%),气滞血瘀证1例(2.3%),肝肾不足证1例(2.3%)。将TCM-SDS评分>1.98分者划分为脾气虚组22例,TCM-SDS评分≤1.98分者划分为非脾气虚组22例;TCM-KDS评分>2.14分者划分为肾虚组19例,TCM-KDS评分≤2.14分者划分为非肾虚组25例。脾气虚组焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、简短癌症复发恐惧量表(FCRI-SF)评分高于非脾气虚组(P<0.05)。肾虚组SAS评分、SDS评分、FCRI-SF评分高于非肾虚组(P<0.05)。44例早中期结直肠癌患者高焦虑程度24例、低焦虑程度20例,高抑郁程度31例、低抑郁程度13例。Alpha多样性分析显示,高焦虑程度患者具有更高的Sobs指数(P<0.05);而高抑郁程度患者Sobs指数更低,但差异无统计学意义(P>0.05)。组间物种差异分析显示,在属水平,高焦虑程度患者肠道菌群中罕见小球菌属丰度高于低焦虑程度患者,而韦荣氏球菌属及毛螺菌属丰度低于低焦虑程度患者(P<0.05);高抑郁程度患者肠道菌群中变形杆菌属丰度高于低抑郁程度患者(P<0.05)。RDA/CCA环境因子分析提示,TCM-SDS评分与高焦虑抑郁程度患者肠道菌群样本分布更为相关(P<0.05),TCM-KDS评分与低焦虑抑郁程度患者肠道菌群样本分布更为相关(P<0.05)。脾虚、肾虚程度与双歧杆菌属丰度呈负相关,而与拟杆菌属丰度呈正相关。结论早中期结直肠癌术后患者心理负担及肠道菌群分布与脾虚、肾虚相关。

Objective TTo analyze the psychological burden and its correlation with gut microbiota distribution in postoperative patients at early and middle stage of rectal cancer.Methods A cross-sectional study was conducted,including a total of 44 postoperative patients with early and middle stage rectal cancer from October 2020 to July 2021 with the diagnosis and treatment through Xiyuan Hospital of China Academy of Chinese Medical Sciences and Peking University Cancer Hospital on psychosomatic rehabilitation platform of integrated traditional Chinese and western medicine.Different TCM characteristic factors were divided by TCM syndrome differentiation,Traditional Chinese Medicine Spleen Deficiency Scale(TCM-SDS)and Traditional Chinese Medicine Kidney Deficiency Scale(TCM-KDS).The distribution of postoperative psychological burden and gut microbiota diversity among patients with different TCM characteristics was analyzed and compared.Species differences were compared,and environmental factors were analyzed to determine the influencing factors of different degrees of TCM characteristics and psychological burden on gut microbiota.Results Among 44 patients with early and middle stage colorectal cancer,there were 20 cases of liver depression and spleen deficiency(45.4%),17 cases of spleen and kidney deficiency(38.6%),4 cases of phlegm-dampness internal resistance(9.0%),1 case of qi stagnation and blood stasis(2.2%)and 1 case of liver and kidney deficiency(2.2%).22 patients with TCM-SDS score>1.98 were divided into spleen-qi deficiency group and 22 patients with TCM-SDS score≤1.98 were divided into non-spleen-qi deficiency group.19 cases with TCM-KDS score>2.14 were divided into kidney deficiency group,and 25 cases with TCM-KDS score≤2.14 were divided into non-kidney deficiency group.The scores of self-rating anxiety scale(SAS),self-rating depression scale(SDS)and brief cancer recurrence fear scale(FCRI-SF)in spleen-qi deficiency group were higher than those in non-spleen-qi deficiency group(P<0.05).SAS score,SDS score and FCRI-SF score in kidney deficiency group were higher than those in non-kidney deficiency group(P<0.05).Among 44 patients with early and middle colorectal cancer,there were 24 patients with high anxiety,20 patients with low anxiety,31 patients with high depression and 13 patients with low depression.Alpha diversity analysis showed that patients with high anxiety had higher Sobs index(P<0.05).The Sobs index of patients with high depression was lower,but the difference was not statistically significant(P>0.05).The analysis of species differences between groups showed that at the genus level,the abundance of micrococcus rariorum in the intestinal flora of patients with high anxiety level was higher than that of patients with low anxiety level,while the abundance of Veillococcus and Chaetomium was lower than that of patients with low anxiety level(P<0.05).The abundance of Proteus in intestinal flora of patients with high depression was higher than that of patients with low depression(P<0.05).RDA/CCA environmental factor analysis showed that TCM-SDS score was more correlated with the distribution of intestinal flora in patients with high anxiety and depression(P<0.05),and TCM-KDS score was more correlated with the distribution of intestinal flora in patients with low anxiety and depression(P<0.05).The degree of spleen deficiency and kidney deficiency was negatively correlated with the abundance of Bifidobacterium,but positively correlated with the abundance of Bacteroides.Conclusion The psycho-emotional burden and intestinal flora of patients with early to mid-stage colorectal cancer are associated with the degree of spleen and kidney deficiency.